Clinical paperOutcome in 757 severely injured patients with traumatic cardiorespiratory arrest☆
Introduction
Patients with traumatic cardiorespiratory arrest (TCRA) are reported to have a poor outcome.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13 Penetrating trauma is associated with a better outcome than blunt trauma due to more isolated organ lesions.6, 10, 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 Taking into account the risks for the medical staff and the potential costs for the admitting emergency department (ED), attempts have been made to identify those patients who may really profit from resuscitation with external chest compressions (ECC).10, 11, 28, 29 Nevertheless, several authors report survival rates of up to 17.9%15, 30, 31 even in blunt trauma. Recent research shows that relevant discrepancies between prehospital and emergency department clinical findings are quite common.15 The criteria of the National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACSCOT) guidelines for withholding or terminating resuscitation with CPR may therefore be too strict.28 The Trauma Registry of the German Trauma Society, representing the German speaking countries of Austria, Germany and Switzerland, contains 20,815 trauma patients with a mean injury severity score (ISS) of 24.0 (database 2005). It shows a rate of prehospital CPR (ECC) of 3.1% and an overall rate of 7.3% of CPR on-scene and/or during the trauma room treatment .32
The purpose of this study was to analyse this database to find out survival rates and predictors for non-survival of trauma patients with traumatic cardiorespiratory arrest. Based on these findings, the significance of resuscitative efforts of severely injured patients is highlighted.
Section snippets
Data collection
The Trauma Registry of the German Trauma Society was initiated in 1993 by the society's “Working Group on Polytrauma” to collect the data of polytrauma victims within German speaking countries (Germany, Austria and Switzerland).33 This trauma registry is a prospective, multicentre, standardised and anonymised documentation of severely injured patients. Variables in the prehospital and trauma room (TR) treatment and in the subsequent intensive care unit (ICU) stay are recorded continuously into
Results
Ten thousand three hundred and fifty nine patients met the inclusion criteria. Among this 10,359 patients were 757 trauma patients that received ECC. Four hundred and fifteen of them were resuscitated in the prehospital phase, 538 during trauma room treatment and 196 in both the prehospital and in-hospital phases. Table 1 gives the main characteristics of the investigated collective.
The mean age of the 757 patients was 40.3 years, 70.7% of the patients were male, 94.3% sustained blunt trauma.
Discussion
Improvements in prehospital care and increasing use of helicopter transport have resulted in more rapid stabilisation and arrival of critically injured patients to trauma centres. At the same time, the cumulative reported experience with traumatic cardiorespiratory arrest seems to indicate that successful resuscitation including chest compressions is rare. In this study, we analysed the Trauma Registry of the German Trauma Society. The collective represents severe blunt trauma victims expressed
Conclusions
Prehospital chest decompression seems to have strong positive impact on probability of survival. If the on-scene trauma team decides to perform CPR bilateral decompression of the chest via chest tube insertion is recommended whenever there is the slightest suspicion of thoracic trauma before rapid transport to the next trauma centre.
Chest compressions in traumatic cardiorespiratory arrest patients is not always futile. The outcome of TCRA patients after chest compressions is generally not
Conflict of interest
There are no conflicts of interest.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at 10.1016/j.resuscitation.2007.04.018.
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See Appendix A.